Prevalence, impact and specialised treatment of urinary incontinence in women with chronic lung disease.

OBJECTIVES: To determine in women with clinically stable chronic lung disease (CLD) and healthy women; (1) prevalence of urinary incontinence; (2) risk factors for urinary incontinence; (3) effects of a standard course of specialised physiotherapy treatment (PT) in women with CLD. DESIGN: Prospective prevalence study; PT study in CLD subgroup. SETTING: Tertiary metropolitan public hospital. PARTICIPANTS: Women with cystic fibrosis (CF, n=38), chronic obstructive pulmonary disease (COPD, n=27) and 69 healthy women without CLD. PT study - 10 women with CLD. INTERVENTIONS: Five continence PT sessions over 3 months. MAIN OUTCOME MEASURES: Prevalence and impact of incontinence (questionnaire), number of leakage episodes (7-day accident diary), pelvic floor muscle function (ultrasound imaging) and quality of life (King's Health Questionnaire). RESULTS: The majority of women in all three groups reported episodes of incontinence (CF 71%; COPD 70%; healthy women 55%). Compared to age-matched healthy controls, women with CF reported more episodes of incontinence (P=0.006) and more commonly reported stress incontinence (P=0.001). A logistic regression model revealed that women with CLD were twice as likely to develop incontinence than healthy women (P=0.05). Women with COPD reported significantly more 'bother' with incontinence than age-matched women with incontinence. There was a significant reduction in incontinence episodes following treatment, which was maintained after three months. CONCLUSIONS: The presence of CLD is an independent predictor of incontinence in women. In older women this is associated with more distress than in age-matched peers without CLD. Larger treatment studies are indicated for women with CLD and incontinence.

Prevalence and impact of urinary incontinence in men with chronic obstructive pulmonary disease: a questionnaire survey.

OBJECTIVES: To identify urinary incontinence and its impact on men with stable chronic obstructive pulmonary disease (COPD) and men without lung disease. DESIGN: Prospective questionnaire study. SETTING: Outpatients attending a public metropolitan hospital. PARTICIPANTS: Men with COPD (n=49) and age-matched men without lung disease (n=36). INTERVENTIONS: Validated questionnaires to identify the prevalence and impact of urinary incontinence. MAIN OUTCOME MEASURES: Prevalence of urinary incontinence and relationship with disease-specific factors, and relationship of urinary incontinence with anxiety and depression. RESULTS: The prevalence of urinary incontinence was higher in men with COPD (n=19/49) compared with men without lung disease (n=6/36; P=0.027). In men with COPD, symptoms of urgency were more prevalent in men with urinary incontinence (P=0.005), but this was not evident in men without lung disease (P=0.101). Only men with COPD reported symptoms of urgency associated with dyspnoea, and this did not vary between men with and without urinary incontinence (P=0.138). In men with COPD, forced expiratory volume in 1 second (FEV1) was lower in those with urinary incontinence compared with those without urinary incontinence {mean 38 [standard deviation (SD) 14] % predicted vs 61 (SD 24) % predicted; P=0.002}. The impact of urinary incontinence did not differ between the two groups (P=0.333). CONCLUSIONS: Incontinence is more prevalent in men with COPD than in men without lung disease. The prevalence of urinary incontinence increases with greater disease severity, as reflected by lower FEV1. Screening for urinary incontinence should be considered in men with COPD and compromised lung function.

Unified total synthesis of the natural products endiandric acid A, kingianic acid E, and kingianins A, D, and F.

A measure of the strength of a synthetic strategy is its versatility: specifically, whether it allows structurally distinct targets to be prepared. Herein we disclose a unified approach for the total synthesis of natural products of three distinct structural types, all of which occur naturally as racemic mixtures. The point of divergence involves the terminal alkylation of a conjugated tetrayne, and culminates in a significantly shortened synthesis of endiandric acid A (8 steps), the first total synthesis of kingianic acid E (8 steps), and a second-generation synthesis of kingianins A, D, and F (11 steps). Evidence for redox catalysis in the biosynthesis of kingianic acid E is presented.

Conjugated triene oxidation products of alpha-farnesene induce symptoms of superficial scald on stored apples.

The sesquiterpene alpha-farnesene (1) and its conjugated triene oxidation products accumulate in the skin of apples after harvest and are implicated as the causal agents of superficial scald. Conjugated triene oxidation products and analogues were synthesized and applied to the surface of Granny Smith apples either as vapors or in squalane. Farnesyl hydroperoxide (2a), trienol (2b), endoperoxide (3a), dehydronerolidol (5), and cumyl hydroperoxide (4) all produced the symptoms of superficial scald when applied at nanomolar doses. Scald-inducing activity was dependent on the mode of application. Farnesyl hydroperoxide (2a) was the most active conjugated triene when applied directly to the apple skin. Trienol (2b) also induced scald symptoms and partially reversed the inhibition of scald caused by diphenylamine.

Monolithiocavitands: versatile intermediates for new cavitand-based hosts.

[figure: see text] Cavitand bowls carrying two derivatizable groups at the rim have been efficiently prepared through a selective lithium/halogen exchange-electrophile quenching procedure. This methodology lends itself to the single-step preparation of the first all carbon-linked bis-bowl and a new class of inherently chiral cavitands.

Stereocontrol of intramolecular Diels-Alder reactions: synthetic studies and transition structure modeling with c5-substituted 1,3,8-nonatrienes and nonadienynes.

An investigation into the endo/exo selectivity and pi-diastereofacial selectivity of ester-tethered intramolecular Diels-Alder reactions is reported. High levels of exo selectivity are realized with terminally substituted dienophiles, and high lk pi-diastereofacial selectivities are induced by the presence of a bulky dioxolanyl substituent at the allylic position of the tether. Precursors 19S, 20S, and 21S, readily prepared from glucose, provide densely functionalized bicyclic lactones of predictable stereochemistry in high yields in enantiomerically pure form upon thermolysis at 110 degrees C. B3LYP/6-31G(d) theory provides good descriptions of transition structures for these reactions and allows an understanding of the formation of the major cycloadducts.